The term “Pap+ Test” describes cervical cancer screening that combines the traditional Papanicolaou (Pap) smear with testing for the Human Papillomavirus (HPV). This approach, formally known as co-testing, utilizes two distinct methods for maximum detection. The dual screening strategy is more sensitive than either test alone, allowing for longer intervals between screenings for many individuals. The goal is to identify cellular changes on the cervix early and detect the underlying viral cause, which drives the progression toward cancer.
Defining the Pap+ Test and Its Purpose
The Pap+ test targets both the effect and the cause of cervical changes. The Pap component, known as cytology, involves a laboratory analysis of collected cervical cells under a microscope. Trained professionals look for morphological changes that suggest the cells are abnormal or precancerous, a condition often called dysplasia. This test is effective at catching cellular irregularities that may have developed due to persistent infection.
The second component is the high-risk HPV test, which specifically looks for the DNA of the viral strains most strongly linked to cervical cancer. Persistent infection with certain high-risk HPV types, particularly types 16 and 18, is responsible for the vast majority of cervical cancer cases. Combining these two tests helps identify precancerous lesions before they advance to invasive cancer. Detecting the virus and resulting cell changes together allows clinicians to better assess a patient’s long-term risk and determine the appropriate follow-up plan.
Preparing for the Procedure and What to Expect
Proper preparation ensures the collected cell sample is clean and accurately reflects the cervical tissue. Patients are advised to avoid douching, using vaginal creams, spermicides, or certain medications for at least two days before the appointment. Sexual intercourse in the 24 to 48 hours prior to the test is also discouraged, as it can cause mild inflammation that may obscure the results. Scheduling the test outside of the menstrual period is recommended, though modern liquid-based cytology methods can often process samples with light bleeding.
The procedure itself is quick and takes place in a medical office setting, generally lasting only a few minutes. The patient lies on an examination table with their feet in stirrups, and a speculum is gently inserted to hold the vaginal walls open. This allows the healthcare provider to visualize the cervix, the lower, narrow part of the uterus. A small brush or spatula is used to collect cells from the surface of the cervix and the endocervical canal, which are then sent to a lab for cytology and HPV DNA analysis.
Interpreting Test Results and Next Steps
Pap+ test results fall into categories, starting with a normal or “negative for intraepithelial lesion or malignancy” (NILM) result. An abnormal result does not typically mean cancer is present, but rather that cell changes or high-risk HPV were detected. Common abnormal cytology findings include Atypical Squamous Cells of Undetermined Significance (ASC-US), which is often the mildest finding. Low-Grade Squamous Intraepithelial Lesion (LSIL) indicates mild changes usually caused by HPV that often resolve on their own.
High-Grade Squamous Intraepithelial Lesion (HSIL) represents more significant cellular changes and carries a higher risk of progressing to cancer, necessitating immediate action. Atypical Squamous Cells, cannot exclude HSIL (ASC-H), also requires prompt follow-up due to the possibility of high-grade disease. When a high-risk HPV result is positive alongside an abnormal Pap result, the risk of precancerous changes is elevated. Follow-up often involves repeat co-testing at a shorter interval, or a colposcopy, where a magnified view of the cervix allows the physician to take targeted tissue samples for a definitive diagnosis.
Current Screening Recommendations
Screening guidelines have evolved to prioritize HPV testing, particularly for older age groups. For individuals aged 21 to 29, the standard recommendation is a Pap test alone every three years, as HPV infections are common in this group and often clear up naturally. Routine HPV testing is not recommended in this younger demographic unless the Pap test result is mildly abnormal, in which case a reflex HPV test may be performed.
For individuals aged 30 to 65, co-testing (Pap test plus HPV test) is the preferred screening option, allowing for an interval of every five years if both results are normal. Alternatively, a Pap test alone every three years remains an acceptable option. Some current guidelines also recommend primary HPV testing, where the HPV test is performed alone every five years, as an effective alternative. Screening can generally be discontinued after age 65 if the individual has a history of at least three consecutive negative Pap tests or two consecutive negative co-tests within the previous 10 years.